Dear Boo:

My cat has severe stomatitis. I knew this when I adopted him from a shelter. But since coming home it has not improved at all. He has had all teeth behind the molars removed, and still it bothers him. Depo shots only help for a very short time! What can I do?

Maggie

Dear Maggie:

Gosh, I know that stomatitis (which is basically inflammation in the mouth – usually involving the cheek pouch area in the corners of the mouth, and often also in the back of the mouth near the throat, as well as the gums, etc.) can be tough to treat in cats. I can tell you that no one knows the cause of feline stomatitis at this time. It is a very painful immune-related oral syndrome.

Here at Cat Hospital of Chicago, the approach that my doctors take with the feline stomatitis patient is this:

1. Detailed pre-anesthetic testing to screen for other diseases that may be contributing to the oral disease and treating them first. This includes a complete blood count, blood chemistries (for kidney and liver problems, as well as diabetes, etc.), viral testing for feline leukemia and FIV, Bartonella testing, etc. (Bartonella is the organism that can cause cat-scratch fever in people. Its association with feline stomatitis is unknown, but is currently being researched).
2. Under general gas anesthesia, biopsies are taken in the mouth. My doctors will often take multiple biopsies, including bone, tooth, and soft tissue to make sure they get an accurate diagnosis. Usually treatment is not instituted until a definite diagnosis is made, because not everything that looks like feline stomatitis really is stomatitis.
3. Next, my doctors will do a very detailed oral exam to evaluate each and every tooth. The gumline is probed and examined on all teeth.
4. Full-mouth intra-oral x-rays are taken. These are taken just like they are in people, from what people tell me. A small dental film is wedged inside the mouth and the x-ray cone is placed right up against the cat’s cheek – and the x-ray is taken! The only way to know if the teeth really need extracting is to evaluate the teeth based on a detailed oral exam, along with dental radiography.
5. Based on dental x-rays, abnormal structures are removed. With diseased teeth, it is especially important that the entire root be removed (and not just the crown). If root pieces remain, inflammation in the mouth may persist because of the pieces of root left behind. In some cases, extraction of all teeth in the mouth needs to be performed, but not always.

In many cases, these steps alone will help to eliminate or at least greatly alleviate the stomatitis problems. In some cases, it may take a long time (even a year, from what I’m told) to get all the benefit from the extractions. If your kitty is still no better with these steps, and is still painful, oral steroids can be tried (or, alternatively, injectable steroids, such as Depo Medrol as you have already tried). Cats are less likely to develop side effects from steroid usage versus dogs and people – but nonetheless, long-term steroid use, especially in the injectable form, is less than ideal (though necessary in some cats). Alternate or additional therapy for resistant feline stomatitis includes antibiotics and other drugs (cyclosporine, chlorambucil, lactoferrin, etc), hypoallergenic (prescription only) diets, vitamins (A, D, E), and laser surgery.

Best of luck with your kitty.

Boo